PDGM and Beyond

Home Health Billing

Need specific, temporary, or longer-term billing support? Let HPS relieve your billing headaches. Our seasoned professionals offer interim billing services that make transitioning to PDGM, managing claims, or helping you take control of your billing department easy and stress-free.

HPS Alliance

As the home health landscape continues to evolve—and regulations change—it’s important to stay informed. Leave the guesswork behind. Become a member of HPS Alliance to get continuous access to exclusive industry resources, ongoing education, and industry-leading consulting. Guarantee that you’re always up to date and that your home health agency is set up for success no matter what by becoming an HPS Alliance member today.


Interested in discussing your needs with a member of our team? Give us a call 615-399-7499 or click the link below to schedule a callback.

PDGM Insights from Our Blog


PDGM Series: Top Five Ways to Avoid Losses!

By Melinda A. Gaboury, CEO / Posted on: February 11, 2020

Agencies across the nation are trying to figure out the best practices for being successful under PDGM. Explore the Top 5 things agencies should focus on to avoid significant losses under PDGM.


PDGM Series: Functional Impairment Scoring & OASIS-D1

By Melinda A. Gaboury, CEO / Posted on: December 9, 2019

Preparing for PDGM: Step 3 in establishing a Home Health Resource Group (HHRG) and case-mix weight is patient Functional Impairment based on OASIS-D1 responses.


PDGM Series: Understanding the First Steps in Patient Grouping—Admission Source and Timing

By Melinda A. Gaboury, CEO / Posted on: November 19, 2019

Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies that are indeed convinced that preparation should be underway. The first two pieces to the puzzle in establishing a Home Health Resource Group…


7 Steps for PDGM Success

For a successful transition to PDGM, Home Health Agencies must develop a thorough understanding of how PDGM changes will affect reimbursement and clinical operations. Agencies should take the following actions to begin preparation for PDGM:

1. Ensure that whoever is finalizing your agency’s ICD-10-CM coding fully understands that the primary diagnosis needs to be specific enough to meet the code list requirements that group patients into Clinical Groupings & the significance of coding all comorbidities/secondary diagnoses that are pertinent to the patient’s care plan and will impact patient care and the Comorbidity adjustment when calculating a case-mix grouping for PDGM.

2. Evaluate your current practice of providing therapy services. Determine how to provide therapy effectively for patient care and outcomes while containing costs. Consider utilizing therapy assistants, telehealth/remote monitoring, etc.

3. Evaluate your HHA’s current revenue cycle process. This will allow you to establish whether or not the agency will need to add staff or outsource billing to manage the increased billing volume.

4. Review Calculations of the impact of the PDGM model on the agency’s reimbursement overall.

5. Review Calculations of the cash flow impact for the first months of 2020 to establish if your agency will need to consider building cash reserves prior to the implementation of PDGM.

6. Review the agency’s Clinical Operations. Establish patient care plans, determine the frequency and duration of visits, and decide how to best reinforce the expectations of continued excellent patient care and outcomes under PDGM.

7. Evaluate the current level of LUPA episodes and how that will vary under PDGM.

Melinda A. Gaboury

Melinda A. Gaboury


D. Mark Cannon, CPA

D. Mark Cannon, CPA


Aaron D. Carey

Aaron D. Carey